August 18, 2020


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Over the past couple of weeks, CMS announced several new initiatives about the future of rural health including the 2021 proposed Physician Fee Schedule and the new Community Health Access and Rural Transformation (CHART) model. Health care in rural America is facing serious challenges, even prior to the COVID-19 public health emergency (PHE). More than 100 rural hospitals have closed in the last ten years and more are at risk, a situation made worse by the pandemic. Rural Americans face limited transportation options, longer travel times to providers, and an older population. In addition, chronic diseases such as heart disease and diabetes are more common in rural communities.

On August 3, the President signed an Executive Order (EO) on Improving Rural Health and Telehealth Access. This EO requires HHS to report on efforts to improve rural health, expand rural telehealth where possible, and work with USDA and FCC on improving physical and communications health care infrastructure in rural areas. The just-released 2021 proposed Physician Fee Schedule would extend many of the telehealth flexibilities enacted during the PHE. These are particularly important in rural areas, as telehealth - especially when the patient can remain at home - can be a lifeline to rural Americans who are many miles from their provider.

On August 11, HHS announced the details of the CHART model, a long-anticipated initiative to improve rural health care. One of the two model tracks, the ACO Transformation track, is an extension of the ACO Investment Model (AIM), a very successful program that provided loans to small rural ACOs to get started in value-based payment. This track provides upfront investment, steady capitated payments, and an emphasis on getting into two-sided risk.

Caravan Health got its start in rural America and has worked since its founding to improve rural health care. Caravan was instrumental in the success of AIM. We sponsored 21 of the 41 participating small rural ACOs that brought in more than half the total savings. The CMS announcement previewed the total results from AIM as an impressive $382 million savings to Medicare from 2016 - 2018.

The CHART Model also includes a Community Transformation track, in which community organizations develop and implement a transformation plan to bring integrated, multi-payer systems of care to rural communities. Both of these tracks will test if upfront investments, predictable capitated payments, and operational and regulatory flexibilities can improve rural care.

The first detailed application information on the Community Health Access and Rural Transformation model will be released next month. Caravan Health is following these developments closely and will stay in touch with our rural partners about potential opportunities to participate. Reach out to us today to connect with us and learn more about how you can participate in these opportunities.

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